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Eur Spine J. 2018 Sep;27(Suppl 6):802-815. doi: 10.1007/s00586-017-5393-z. Epub 2017 Dec 27.

The Global Spine Care Initiative: a systematic review of individual and community-based burden of spinal disorders in rural populations in low- and middle-income communities.

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Office of Public Health Studies, University of Hawai`i, Mānoa, Honolulu, HI, USA.
Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.
UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada.
Rehabilitation Centre, San Cristobal Clinic, Santiago Spine Group, Santiago, Chile.
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark and Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, USA.
Department of Neurology, University of California, Irvine, CA, USA.
World Spine Care, Santa Ana, CA, USA.



The purpose of this review was to synthesize literature on the burden of spinal disorders in rural communities to inform the Global Spine Care Initiative care pathway and model of care for their application in medically underserved areas and low- and middle-income countries.


A systematic review was conducted. Inclusion criteria included all age groups with nonspecific low back pain, neck pain, and associated disorders, nonspecific thoracic spinal pain, musculoskeletal chest pain, radiculopathy, or spinal stenosis. Study designs included observational study design (case-control, cross-sectional, cohort, ecologic, qualitative) or review or meta-analysis. After study selection, studies with low or moderate risk of bias were qualitatively synthesized.


Of 1150 potentially relevant articles, 43 were eligible and included in the review. All 10 low and 18 moderate risk of bias studies were cross-sectional, 14 of which included rural residents only. All studies included estimates of low back pain prevalence, one included neck pain and one reported estimates for spinal disorders other than back or neck pain. The prevalence of low back pain appears greater among females and in those with less education, psychological factors (stress, anxiety, depression), and alcohol consumers. The literature is inconsistent as to whether back pain is more common in rural or urban areas. High risk of bias in many studies, lack of data on disability and other burden measures and few studies on conditions other than back and neck pain preclude a more comprehensive assessment of the individual and community-based burden of spinal disorders in less-developed communities.


We identified few high-quality studies that may inform patients, providers, policymakers, and other stakeholders about spinal disorders and their burden on individuals and communities in most rural places of the developing world. These findings should be a call to action to devote resources for high-quality research to fill these knowledge gaps in medically underserved areas and low and middle-income countries. These slides can be retrieved under Electronic Supplementary Material.


Back pain; Global burden of disease; Neck pain; Spine

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